Watch the September clinical update from Jo Scott-Jones joined by Dave Maplesden, Pinnacle GP liaison in this 48 minute video. (Written version below.)
Clinical snippets are now available as a podcast too! Search on your favourite podcast platform for The New Zealand General Practice Podcast to listen, or click here to listen on Anchor.
BPAC has recently updated their resource on identifying the risk of serious illness in children with fever. Practice points include:
The August NZF changes include an update on sections related to pain management including a new guidance section on Opioid choice (where you can find a variety of conversion tables) and a section on Complex regional pain syndrome emphasising the importance of early diagnosis using the Budapest criteria, and early referral to specialist pain services and physiotherapy. There are additional updates in the following sections:
The Goodfellow Unit has published a webinar on EPOAs (35 mins) which is worth a listen. I regularly see complaints regarding EPOAs including assessments for activation, failure to communicate communicating with an activated attorney or communicating with a an attorney without patient consent when the EPOA has not been activated.
Take home messages from the presentation
A recent Goodfellow Unit Gem looked at the role of ACE/ARBs in patients with microalbuminuria.
A Goodfellow Unit short course (30 minutes) on pharmacological management of CKD was published in July this year.
Issue 110 of Māori Health Research Review included comment on Te Matahouroa: a feasibility trial combining Rongoā Māori and Western medicine in a surgical outpatient setting - recently published in the NZMJ. The trial involved six patients (diagnoses of various cancers) who met with both a Rongoā Māori practitioner and a Western trained surgeon during three 45-minute appointments over a 6-month period. Patient whānau were welcome and kai was provided. The study notes benefit to the participants across multiple themes presented as extracts from qualitative interviews. Barriers and facilitating factors are discussed. This would be very useful reading for anyone contemplating increasing the use of Rongoā Māori as part of their Māori health practice plan.
Additional resources for Rongoā Māori include:
A 2022 article Adapting Traditional Healing Values and Beliefs into Therapeutic Cultural Environments for Health and Wellbeing giving excellent background into the principles of Rongoā Māori and adapting these principles into our current environment.
Issue 13 of GP Practice Review refers to recent guidelines from the Princeton Consensus Conference that describe best practice on the evaluation and management of male patients with CVD and erectile dysfunction. Many males with CVD, either overt or undiagnosed, experience erectile dysfunction. In addition, erectile dysfunction is associated with an increased risk of CV events, even among males without established CVD.
The guidance includes...
When consulting with male patients with confirmed erectile dysfunction and known CVD, the following steps are recommended:
The exertion of sexual activity between couples in a longstanding relationship equates to approximately 2 to 3 METS, which is equivalent to walking 1 mile on a flat surface in 20 minutes or climbing 2 flights of stairs in 10 seconds. Younger couples may expend 5 to 6 METS while engaging in more intense sexual activity (equivalent to approximately 4 minutes of standard Bruce Protocol Treadmill Test).
The guideline provides several algorithms and tables to assist in the assessment and risk stratification of patients. The possibility of using non-PDE5 inhibitor therapies is also discussed as is the safety and efficacy of PDE-5 inhibitors in female patients.
I have recently looked at case of delayed diagnosis/delayed management of Charcot neuro-arthropathy (Charcot foot).
[1] Martin E. Diabetic neuroarthropathy. Uptodate. www.uptodate.com Accessed 25 August 2024
Kathy joined Pinnacle earlier this month as clinical diabetes specialist for Waikato, replacing the role previously held by Anne Waterman.
Read moreThe Special Authority criteria for Concerta and Ritalin LA has been amended. This removes the criterion allowing treatment initiation on to Concerta or Ritalin LA if unable to access Teva-ER due to supply issues. This is because all strengths of Methylphenidate ER - Teva, are available again. However supply of Concerta is now constrained.
Read moreThis programme provides funding for Aclasta infusions for eligible patients. The infusion is to be provided in the community by the patient’s general practice.
View detailsA guide for clinical management of type 2 diabetes, to support nurses at all levels to develop their knowledge and clinical reasoning in diabetes care.